In 2009, the United States Census reported that of the 285.7 million individuals in the U.S. population over 5 years old, 20 percent (or 1 in 5) speak a language other than English at home. Approximately 8.6 percent speak English less than “very well”.
Access to healthcare for this Limited English Proficiency [“LEP”] group is challenging. In an article “Access to Hospital Interpreter Services for Limited English Proficient Patients in New Jersey: A Statewide Evaluation”, Glenn Flores, M.D., et al, reported on studies that found fewer preventative care measures such as mammograms and PAP smears, a higher probability of drug complications and hospital admissions and misunderstanding of “diagnoses, medication and follow-up” as well as other risks.
The Pennsylvania Patient Safety Authority recently released the results of a study of the challenges in Pennsylvania in “Managing Patients with Limited English Proficiency” in its March 2011 Pennsylvania Patient Safety Advisory.
The authors reviewed 232 cases reported to the Authority in 2004-2010 that were characterized as LEP-associated problems. Of these, 40 percent involved falls by patients, 27 percent were errors or complications in surgical procedure and 6 percent were related to medicine.
The cases disclosed several deficiencies. The most glaring deficiency is the failure to offer the LEP patient access to a trained interpreter. One study that was cited by the Advisory indicated that an interpreter was not provided to 46 percent of the LEP patients visiting an Emergency Room.
Equally problematic is the fallback position wherein a friend or family member fills in as an interpreter. In a comment by Dr. Flores, the provider may rely on an individual who accompanies the LEP patient to the hospital, quite possibly someone without language proficiency in both languages.
According to the Advisory, some protections exist for individuals under federal law, specifically Title VI of the Civil Rights Act of 1964, and federal guidelines published by the U.S. Department of Health and Human Services and national standards on informed consent published by the National Quality Forum. In Pennsylvania, the Advisory cites Pennsylvania Title VI as covering physicians and hospitals that obtain federal money.
Access to such services has been found to improve not only patient satisfaction but also to improve the quality of care.